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How Does It Work?:
Discomfort of weight bearing Joints (OA) is a slowly progressive problem characterized by a continual breakdown of articular cartilage. The joints most often affected by OA are the knees, hips, spine, and hands. Clinical manifestations of OA include Discomfort, stiffness, and decreased range of motion of the affected joints.

Glucosamine is an aminomonosaccharide, a product of the addition of an amino group to glucose. It occurs naturally in the body. Glucosamine is a basic building block for the biosynthesis of glycosaminoglycans (GAGs) and proteoglycans (PGs) (giant molecules with many GAGs attached), which are important constituents of the articular cartilage. It also is required for the formation of lubricants and protective agents for the joints. Glucosamine has been reported to stimulate PGs synthesis in articular cartilage inhibit degradation of PGs, and provide the building blocks to maintain healthy cartilage and joints.

Glucosamine sulfate is the sulfate salt of glucosamine. In solution or in the human body, glucosamine sulfate dissociates into glucosamine and sulfate ions. The sulfate moiety plays an important role in the synthesis of PGs, because the constituent GAGs are highly sulfated. Depletion of sulfate leads to decreased synthesis of GAGs, and sulfate administration counteracts the deleterious effect of sulfate depletion.

Glucosamine sulfate is highly hygroscopic, which means it attracts and absorbs water very easily, by nature. The amino group in the molecule is likely to be oxidized, which causes degradation of the molecule, if it is not stabilized by sodium and chloride. This constitutes a non-hygroscopic substance, which is stable at normal temperature and relative humidity. To date, more than 20 clinical studies using glucosamine sulfate have been reported, with nearly 3,000 patients receiving either glucosamine sulfate or placebo. These studies show a favorable response to glucosamine sulfate vs. placebo in supporting healthy joint function.

Precautions:
Glucosamine sulfate has been administered safely to individuals with a variety of conditions, including circulatory disease, liver disorders, diabetes, lung disorders, and depression, with no observed interference with either the course of the illness or pharmacological treatment for these conditions. However, a small number of transient mild gastrointestinal problems have been associated with ingestion of glucosamine sulfate. These complaints are generally mild and are reversed when glucosamine sulfate is discontinued. Additionally, taking the product with meals may alleviate mild gastrointestinal distress.

Recently, a concern has been expressed about the potential for glucosamine to induce insulin resistance. The possibility of glucosamine induced insulin resistance is a speculation based on animal studies.⁹ To date, no abnormalities in glucose metabolism have been reported in individuals taking glucosamine sulfate.

In healthy individuals, a single dose of glucosamine hydrochloride (20 grams) was found to have little influence on blood glucose levels or the effect of insulin on blood glucose levels. In addition, administration of 1.5 grams of glucosamine sulfate for more than two weeks showed no significant changes of blood glucose levels in osteoarthritis patients and osteoarthritis patients with diabetes. Furthermore, a placebo-controlled study with glucosamine sulfate reported a trend of decreased blood glucose levels in subjects with or without diabetes mellitus during a 4-week period.

In a larger 3-year study, the same results were found: a trend of decreased blood glucose levels in subjects with or without diabetes mellitus. A recent study with fifteen non-diabetic subjects showed that administration of glucosamine sulfate (500 mg three time daily) for 12 weeks did not change fasting glucose levels.

Although a trend in increasing fasting insulin levels was reported in an April 2000 study with fifteen non-diabetic subjects, the results of this study need to be replicated and confirmed in a larger controlled trial before any conclusion can be drawn regarding the relationship between the use of glucosamine sulfate and insulin resistance. The National Institutes of Health (NIH) has recently sponsored the first study in the United States to evaluate glucosamine and chondroitin in patients with osteoarthritis.¹⁴ Until high quality studies, such as the NIH study, are completed, it may be prudent for individuals with diabetes or a predisposition for diabetes to work with their licensed healthcare professional to monitor blood sugar and insulin levels if they are taking glucosamine sulfate.